Snapshot A 57-year-old man presents to the emergency department complaining of chest pain and swollen feet three days after visiting his family for the holidays. He has a history of chronic alcohol abuse. Introduction Overview most common form of cardiomyopaty dilated cardiomyopathy leads to systolic dysfunction Etiology alcohol abuse beriberi Chagas' disease (in South America) coxsackievirus (postviral myocarditis) cocaine use doxorubicin toxicity hypertension ischemia peripartum cardiomyopathy tachycardia Presentation Symptoms dilated cardiomyopathy, like other forms, may present as acute onset slowly progessive symptoms symptoms include exertional dyspnea edema fatigue loss of appetite cough Physical exam classic signs of CHF swelling legs lung sounds JVD hepatomegaly Evaluation Echocardiography is most definitive diagnosis shows dilated ventricles confirms decreased EF CXR often shows balloon-like heart Differential Other cardiomyopathies, and other causes of CHF Takotsubo cardiomyopathy (transient apical ballooning syndrome aka stress induced cardiomyopathy) Classic "heart break" disease - induced by stress (ventricular wall weakening, decreased contractility) Takutsubo = Japanese octopus trap (heart resembles these traps) Treatment Tends to self resolve in months - usually supportive therapy β-blockers and aspirin can be helpful Treatment Nonoperative medications directed at improving cardiac function ACEIs/ARBs β-blockers spironolactone digoxin for symptom improvement - does not improve mortality Prevention, Prognosis, and Complications Prognosis good with appropriate treatment and lifestyle modifications Prevention diet and exercise smoking cessation limit alcohol intake Complications arrhythmias CHF pulmonary edema side effects of CHF medications